Mental health and substance use disorders are highly prevalent among incarcerated individuals. Many prisoners reenter the community without receiving any specialized treatment and return to prison with existing behavioral health problems. We consider a Beckerian law enforcement theory to identify different channels through which access to healthcare may impact ex-offenders’ propensities to recidivate, and empirically estimate the effect of access to public health insurance on criminal recidivism. By exploiting variation in state Medicaid expansion decisions, we find that increased access to healthcare through Medicaid coverage reduces recidivism among offenders convicted of violent and public order crimes. The decomposition of recidivism rates shows that this reduction is driven by marginal recidivists who, but for Medicaid expansions, would be reconvicted for the type of crime for which they were previously convicted. Analyses of potential mechanisms show an increase in criminal justice referrals to addiction treatment, which may reduce impulsive behavior. Back-of-the-envelope calculations also indicate that there are substantial cost reductions from providing Medicaid coverage to former inmates.

中文翻译：

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公共健康保险对刑事累犯的影响

心理健康和物质使用障碍在被监禁的个人中非常普遍。许多囚犯在没有接受任何专门治疗的情况下重新进入社区，并带着现有的行为健康问题返回监狱。我们考虑贝克尔执法理论来确定获得医疗保健可能影响前罪犯再犯倾向的不同渠道，并根据经验估计获得公共医疗保险对犯罪再犯的影响。通过利用州医疗补助扩展决策的变化，我们发现通过医疗补助覆盖增加获得医疗保健的机会可以减少被判犯有暴力和公共秩序罪的罪犯的累犯。累犯率的分解表明，这种减少是由边缘累犯驱动的，如果不是医疗补助扩张，将因他们先前被定罪的犯罪类型而被重新定罪。对潜在机制的分析表明，对成瘾治疗的刑事司法转介有所增加，这可能会减少冲动行为。粗略计算还表明，向前囚犯提供医疗补助保险可以大幅降低成本。